Massachusetts, individually and as parents of___________________________________,

a minor under the age of eighteen (18) years, in consideration for the opportunity afforded to my child at “West Roxbury School of Dance,” offered at 49 Corey St. in West Roxbury, Massachusetts 02132, hereby agree and consent to release and forever acquit Emily Kingsbury, Dance Instructor, DBA as West Roxbury School of Dance, from any and all claims or liability for damages for any occurrence in connection with the dance and exercise classes, which may result in injury or other damages sustained by my child while participating in classes or otherwise at “West Roxbury School of Dance.” In further consideration of the opportunity afforded to my child to participate in this instruction, I hereby personally assume all risks in connection with the said course. I have fully informed myself of the contents of this registration form and release by reading it before I sign it. My child is physically fit to participate in this course and I am not aware of any injuries or illness, which would limit such participation.